A silent disease


  • Health
  • Sunday, 11 Mar 2012

THE problem with chronic kidney failure, says Hospital Selayang consultant nephrologist Dr Rafidah Abdullah, is that it is a silent disease.

Patients don’t often have symptoms until they have reached the last stage of the disease, when their kidneys are only functioning at about 15% of their capacity.

By that time, they will have already become dialysis-dependent, she says, meaning that such patients will not be able to survive without daily dialysis treatments.

“A lot of times, patients don’t know that they have gone into kidney failure because it is picked up at such a late stage,” says Dr Rafidah.

She opines that this is due to a number of factors.

One is that the symptoms of kidney failure are very vague and general, and can be due to numerous other medical conditions. These symptoms include nausea, vomiting, tiredness, and difficulty in eating, among others.

Another factor is the low awareness about the condition among both the general public and doctors, although Dr Rafidah feels that this situation is slowly improving.

The scary part is that this silent disease is very common, affecting one in every 10 Malaysians, according to her.

She says: “The number one cause of kidney failure in Malaysia is diabetes, followed by unknown causes.”

In 2010, 56% of new dialysis patients were caused by diabetes mellitus, followed by 30% from unknown causes.

Dr Rafidah however, suspects that many of the “unknown” causes are due to hypertension – another common condition suffered by many Malaysians.

And while survival rates on dialysis are not too bad, the odds become much worse if the patient is diabetic.

“Forty-three percent of diabetics on dialysis survived to five years, versus 65% of non-diabetics,” she shares.

While dialysis patients are perfectly capable of leading a fairly normal life outside of their treatments, the problem lies in the time-intensive sessions they have to undergo.

Over 90% of Malaysian kidney failure patients are on haemodialysis, which requires patients to go to a specialised centre three times a week for four hours each time. And this, says Dr Rafidah, is not including travel time, and the pre- and post-preparation times needed for the dialysis.

Nephrologists would like more patients to go on Continuous Ambulatory Peritoneal Dialysis (CAPD), where they can perform the needed procedure by themselves at home, or anywhere appropriate.

This form of dialysis needs to be done four times a day for about 15 minutes each, and offers a higher form of independence to patients.

“But only 8% of Malaysian patients are on CAPD, compared to South Korea, which is 99%,” says Dr Rafidah.

The only hope for patients to get off dialysis is to undergo a kidney transplant from a suitable donor.

In Malaysia, there are only two (legal) ways of getting a kidney: from a willing family member, and from a brain-dead pledged organ donor.

Dr Rafidah estimates that the donation rates between the two sources are equal at about 50% each.

“It’s very clear that the outcome in terms of complications is better, and life is much longer. It’s like a gift of life,” she says.

But the problem is that Malaysia has an extremely low organ donation pledge rate. “It’s one of the lowest all over the world. It is very, very sad,” she says.

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